Healthcare Provider Details

I. General information

NPI: 1871601039
Provider Name (Legal Business Name): CAMPBELL FAMILY PRACTICE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 E HIGHWAY 76 SUITE 6
MULLINS SC
29574-6038
US

IV. Provider business mailing address

PO BOX 1033
MULLINS SC
29574-1033
US

V. Phone/Fax

Practice location:
  • Phone: 843-431-9882
  • Fax: 843-431-9879
Mailing address:
  • Phone: 843-431-9882
  • Fax: 843-431-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TREADWELL CAMPBELL
Title or Position: DIRECTOR/OWNER
Credential: M.D.
Phone: 843-431-9882